Background. The purpose of this research was to assess the prevalence of somatic and psychosomatic health complaints in a cross-national population of university students and to study risk factors associated with health complaints. Methods. The analysis was based on samples of first-year students from Pamplona (Spain), Bielefeld (Germany), and Kaunas (Lithuania). The total sample included 2343 students. Ten health complaints were measured by a symptom checklist with a self-administered questionnaire. Sociodemographic and lifestyle data were also collected. Factor analysis was employed to develop three complaint scores. Results. Multifactorial logistic regression analysis revealed substantial associations between the factors female gender and psychosocial stress and high levels (>median) of complaint scores. Furthermore, after adjustment for age, sex, and lifestyle variables Lithuanian students were less likely to report gastrointestinal complaints (OR 0.62, CI 0.43-0.90) and neck ache/backache (OR 0.41, CI 0.28-0.61) compared to Spanish students. In addition, German students were less likely to report psychosomatic (OR 0.49, CI 0.35-0.69) and gastrointestinal complaints (OR 0.47, CI 0.34-0.65) than their Spanish peers. Conclusions. Although the results cannot be generalized to the general population of the respective countries, the different profiles of reported complaints should give rise to special interventions in this young population. (C) 2003 American Health Foundation and Elsevier Science (USA). All rights reserved.